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Science or Quackery? The Study of Hormones Has Been Both, a New Book Suggests

AROUSED
The History of Hormones and How They Control Just About Everything
By Randi Hutter Epstein
313 pp. W.W. Norton & Company. $26.95.

This is a well-written and informative book about the history of hormone research. The interested reader will learn how scientists have come to understand what hormones are and how they function. But it is also deeply disturbing: for what this history entails, for how the author tells it and for what she leaves out.

“Aroused” is organized around scientific and medical episodes from the 19th century to the present, many of which involved dubious and unethical practices. Among the central characters are doctors who promoted vasectomy to enhance male youthfulness, who operated on patients without their knowledge and who experimented on their own children. Randi Hutter Epstein, the author of “Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank,” tells us of a journalist paid by a doctor to ghostwrite glowing articles about testosterone therapy and of a physician who kept a 17-month-old baby boy in the hospital for a month while he performed experimental genital surgery without parental support; the doctor then sent the child home instructing the parents to expunge all evidence that “she” was ever a “he.”

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Even more disturbing than reading about these practices is that for the most part Epstein shrugs them off, saying that the physicians involved were well intentioned, that what they did was appropriate for their day or that they did what they could with the information they had. These were the “best practices of the time.” It was “just the way things were.” But that’s not quite true: Some of these practices were questioned even at the time. And it doesn’t take hindsight to recognize hubris.

In a chapter titled “Pickled Brains,” Epstein seems to delight in the macabre spectacle of abandoned organs in a university basement. The brains were collected for research in the early 20th century; she notes that to handle them now requires compliance with biohazard regulations yet she fails to explain why. Neither does she tarry much over the ethical medical treatment of human remains. Consider Charles Byrne, the so-called Irish giant who in the late 19th century became the object of public attention. Byrne anticipated that after his death, physicians would want to study and perhaps display his body, so he instructed friends to seal his coffin and dispose of it in the ocean. They agreed, but Byrne’s directive was circumvented when the prominent physician John Hunter arranged for the cadaver to be stolen and the skeleton displayed in the Hunterian Museum, London, where it remains today. Numerous historians, ethicists and laypeople have objected to the continued thwarting of Byrne’s wishes; Epstein reduces this complex and important matter to a footnote.

Epstein contrasts “quackery” with “legitimate research,” and “craziness” with “serious science,” but the crucial question of how to distinguish between them is unaddressed. Many of the dodgy practices she describes were undertaken by credentialed medical doctors and scientists. Today, testosterone therapy for virility is endorsed by people with medical degrees, but there is little evidence of its efficacy. Epstein offers no guidance on how we might evaluate the untested or otherwise problematic therapies on offer today. If we were to adopt her stance that this is “just the way things are,” we would have no way to judge, and therefore no basis on which to object to current dubious practices.

Epstein also elides the problem of hormone-disrupting chemicals. Among the reasons hormones long eluded scientific understanding is that they can be effective at minuscule doses, and the body is acutely sensitive to when those doses are released. One of the great advances of late-20th-century science was to understand this; another was to recognize that some synthetic chemicals — most notoriously the pesticide DDT but also many others — can mimic hormones with great adverse effect. (DDT was banned in part because it was killing bald eagles by disrupting their reproduction.)

These chemicals are toxic, but not in the way that lead or mercury or arsenic is. Rather, they alter endocrine function: hence the moniker endocrine-disrupting chemicals or EDCs. The human health effects of EDCs are not entirely understood, but the list of potential problems is long: prostate and breast cancer, infertility, fibroids, endometriosis, male and female reproductive dysfunction, birth defects, disrupted immune function, obesity, diabetes, cardiopulmonary disease, neurobehavioral and learning dysfunctions like autism, hermaphroditism and alternation of sexual identity in animals. One estimate places the cost of the disease burden at $340 billion. Surely a book on the history of hormone research should have something to say about that.

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